The blog is about health and gives useful information on health and disease.

AIDS has received wide publicity in recent years. It is important to remember that it is still a rare disease in children in this community. Infected children have usually acquired AIDS from their mothers, in particular during pregnancy if she is infected. In the past there was a risk of contracting AIDS through transfusions with contaminated blood. All blood is now carefully screened for HIV (Human Immunodeficiency Virus, which causes AIDS). Children infected with HIV are likely to develop AIDS. This causes marked suppression of their immune system, and they are prone to developing life-threatening diseases. There is currently no cure for AIDS, although certain drugs being developed show promise.

The HIV virus is spread by the exchange of human fluids such as blood or semen. It cannot be acquired by direct body contact or by kissing. There is no danger of your child contracting HIV by coming into normal contact with another child or adult who has HIV, unless there is an exchange of bodily fluids.

A family who has a child with AIDS requires expert medical and counselling support. If you need further information, contact your doctor. Each state has organisations which provide both information and support to those with AIDS and their families.

Your children know a lot already, but they think they know a lot more than they do, and a lot of what they know just is not so. What they know something about is the mechanics, but much less about values and right and wrong. They wonder about love, about how and what to do with whom sexually. They want to know what love is, what it means, how you know when you are in love. Start talking about that openly and see how much

discussion takes place. Another guideline is that the more they pretend to know, the more mechanical and mythological their knowledge really is. Teens seldom come to you and say, “You know, Mom and Dad, I’m really very vulnerable and immature. Your experience is so much broader than mine. Could you please fill me in?” Such statements may occur only when there is emergency need to use the family car, not when there is real need to know.

There are really four basic areas that need to be addressed. These are what I call the “BARE” facts. Â stands for biology. As I have said, many kids have learned something about the basic biology of sex. You may want to make sure all four, not just the first three perspectives of sexuality, are a part of your children’s biological knowledge. Most formal sex education emphasizes the same genital/energy approach of the early sex perspectives, not the fourth perspective of this twenty-first-century marriage manual.

R stands for reproduction. They need to know about menstruation, conception and contraception, sexually transmitted diseases, responsibility for sex, children, and family.

E stands for emotion. They need to know about your feelings, be able to clarify and express their own feelings. An important warning here! Your feelings, their feelings, change. Sometimes they may shock you and test you. Give it some time. They may try a feeling out for a while. Teenagers particularly use the “feeling for a day” system of trying out for life. They are less moody than they act, and they do tend to “act” moody. Don’t overreact, because overreaction is what they are testing for and afraid of, in you and within themselves. When you overreact, teens go from the more acceptable playacting and testing of parents to acting-out, which almost always signals unexpressed feelings of helplessness.

He gestured with his hand as if he were erasing a chalkboard. “On and on and on. I work on her until she comes. She has two, maybe even three or four orgasms, then it’s my turn.” The husband described his typical patterned sexual process of pleasing as if it were an indelible code of sexual marital conduct.

“I know, and I feel worked on,” said the wife as she grabbed his hand from its circular path, took it in her own, and held it in her lap. “It’s like I have to come, usually a couple of times, for him to feel that he has done his job. Then he does it. I feel like a prerequisite instead of a partner.”

“Name one time, just one time we have ever had sex when you were not completed,” demanded the husband as he pulled his hand from hers and rested it in his own lap. “You are satisfied every damned time. I make sure of it. I know how it is with women. I know that they, I mean you, can go on and on and need a lot to get going but then you keep going.” His hand returned to its circular motion in the air. “I just use this technique and you know it takes work. I can’t believe after all of these years you don’t appreciate the fact that I take your feelings into account. Some men just don’t care. At least I’m not the T don’t care as long as I’m happy’ type.”

The first three perspectives freed women^ at least theoretically, to be sexual persons, to respond, to enjoy, to be orgasmic, to be multiply orgasmic, to have sexual choices. Women were viewed as not only the erotic “equals” of men, but as somehow sexually superior, mystical persons with sexual capacities far exceeding those of men. In fact, their sexual-response model was seen not only as different, but as a goal, the standard against which the male sexual capacity fell woefully short. They became ”sexual witches” with almost magical sexual powers.

As many as nine million women were murdered in the 1500s and 1600s, burned, hanged, and tortured as possessed with erotic demons. The Malleus Maleficarum (The Witches’ Hammer) was written in 1486 by Heinrich Kramer and James Sprenger. They wrote mat “all witchcraft comes from carnal lust which is in women insatiable.” Early sex researchers unknowingly gave indirect physiological and alleged psychological credence to the idea that women were much different, much more erotic, much more sexually responsive than men. The evil ascribed to women was related to their mysterious sexual prowess, the “evil woman” syndrome.

One feature which may be misinterpreted is a feeling of well-being before the attack.

A woman may wake up feeling great. She does all her cleaning, shopping and other tasks she, maybe, has put off for some time. Next day she wakes with a splitting migraine and blames overdoing it for causing the headache.

The typical migraine headache starts with some warning, usually a disturbance in vision. The headache is usually throbbing in character and, in a third of cases, is on one side only. Nausea and vomiting are common.

Pain is the commonest warning signal that something is wrong with our bodies. Pressure on nerves anywhere in the body will usually result in pain as the main symptom.

At the front of the wrist there is a groove formed by the small bones of the wrist. Lying in this groove and passing through it, as though a tunnel, run the tendons that flex the fingers and also the median nerve.

This nerve carries sensations from the thumb, index finger, middle finger and half the ring finger. It also carries nerve fibres to some of the muscles of the hand.

Roofing over and converting the groove into a tunnel is a broad band of ligament tissue. The median nerve can be compressed as it runs through this tunnel and cause the condition known as carpal tunnel syndrome.

This disorder is more likely to occur in the middle-aged. The cause is unknown although occasionally it is attributed to work, but this is not always definite. It may occur in the young as the presenting feature of rheumatoid arthritis. In this condition it is the swelling of the tendon sheaths which compress the nerve.

You may initially feel very apprehensive about insisting on this. Let me tell you from my experience with many patients that your imagination will usually paint a far gloomier picture than the truth. It is much easier to grapple with facts than with the unknown. It is impossible to make good decisions in a black cloud of ignorance. These are very good reasons for insisting on the facts.

I know that some of you will be seeking information, advice and treatment from people other than medical-school trained doctors. I wish to make it clear that my training was as a medical doctor. I worked in a large teaching hospital. This is where my experience lies and it is what I understand best. Because of this, you will find that all the detailed explanations in this book concern the methods of diagnosis, assessment and treatment used by medical practitioners. In these sections I will use the word doctor to mean medical-school trained doctors. Some sections of this book, including all of this chapter, apply whether or not the cancer ‘expert’ you are consulting is a doctor. In these sections I will use the word ‘practitioner’ to mean whoever is looking after you, whatever their training.

Since the skin lacks adequate natural defence mechanisms against the damaging effects of UV radiation, total sun avoidance, the wearing of protective clothing, or the application of sun screens is necessary to protect it The latter is obviously more acceptable, and as people have become more conscious of the dangers associated with sun exposure, there has been greater awareness and use of these products.

A sun screen is a product intended for application to the skin to reduce the intensity of UV radiation reaching it. It should be easy to apply, form a thin invisible film, and resist removal by perspiration and swimming. Most importantly, it should be a broad spectrum screen, which absorbs both UVA and UVB radiation. It used to be thought that UVB radiation was the only wavelength to cause burning and permanent sun damage. So these wavelengths were the first to be screened out. However, it is now clear that both UVA and UVB are the cause of premature skin ageing and skin cancer. Therefore, newer preparations known as broad spectrum preparations are the ideal sun screens for Australian conditions. Furthermore, it should be made quite clear that a tan does not protect the skin from cancer-producing wavelengths even though it may prevent sunburn. Sun screens should be applied to dry skin, preferably half to one hour before sun exposure, and be reapplied if sweating is profuse or swimming frequent. The best chemical combinations currently available are those containing either the aminobenzoates or cinnamates, which preferentially absorb UVB, and benzophenone, which absorbs UVA.

The Health Departments and Anti-Cancer Councils in Australia classify sun screens by relating them to the percentage of UVB wave lengths which they screen from the skin. Most products from the United States and Europe, however, are labelled according to their Sun Protection Factor or S. P. F. This value is essentially an indication of how much the period of sun exposure can be prolonged without risking severe sunburn. An S.P.F. of 4 would mean that the product will allow the user to enjoy the sun four times longer than would be possible without protection. For the average individual this would mean an exposure of 40-60 minutes. Since the various products available for the Australian market vary greatly with respect to their S.P.F., the level of protection should be specified in order to simplify the consumer’s choice. Furthermore, it should be made clear that the broad spectrum preparations, although fewer in number, are the ideal choice for Australian conditions.

The only totally effective method of preventing sunburn and the more severe permanent signs of skin damage is to completely avoid the sun. A more satisfactory solution is to apply an effective sun screen preparation every morning as part of one’s daily grooming, along with such routines as hair combing and teeth cleaning. This is necessary in Australia and other sunny climates because of the cumulative effect of the sun from birth onwards. It is the number of hours of exposure to the sun, rather than the intensity of any single exposure, which is the crucial factor with regard to the onset of premature ageing and the formation of skin cancer.

Hot flushes and night sweats belong in a category of symptoms that doctors call ‘vasomotor symptoms’, that is they are concerned with the blood vessels dilating and constricting, and with the flow of blood through these vessels. The symptoms are harmless, but most women greatly dislike having them, and find them uncomfortable, embarrassing and unpleasant. They may also affect a woman’s ability to cope at work and at home, and she may even avoid social contact for fear of feeling ashamed.

The typical hot flush starts as an unpleasant sensation of heat in the face, neck or body. If it starts in the face or neck, it will probably spread down to the main part of the body; if it starts there it will spread up to the face. Often the face becomes red, and sweat appears; but many women find, to their surprise, that, despite the feelings of great heat in their face, there are no outward signs at all, and nobody has noticed.

Flushes may occur at intervals from several each hour, to just a few times each month, usually in the days leading up to the start of a period. There will be times when flushes occur frequently, and times when they do not occur at all. Each flush may last for a few seconds, or for up to half an hour, or more, but most last for about three minutes. After a flush, you may feel sweaty, then cold, and you may seem to be endlessly taking clothes off and putting them on again to get comfortable. Flushes can occur at any time of the day or night, and may be accompanied by heart palpitations, dizziness and feelings of faintness. In America, they are called ‘hot flashes’, but this is a less appropriate name, as it suggests something that comes and goes very rapidly. The British term ‘hot flush’ describes more accurately the feeling of heat that builds up and dies down slowly.

When flushes occur at night, they are called ‘night sweats’. Typically, a woman will wake from sleep to find she is drenched in sweat and has to get up to change her night-clothes, and perhaps even the bedding. Night sweats cause greatly disturbed nights and lack of sleep, for the woman suffering them and perhaps also for her partner who may find himself woken several times in the night as she gets up to wash and change into something dry. Repeated broken nights cause fatigue, loss of concentration, irritability, and a general sense of lethargy.

It is thought that the falling level of oestrogen throws the body’s heat-controlling mechanism into confusion, and the ‘thermostat’ becomes set too low. The result is that the body thinks it is suddenly too hot, so it dilates the blood vessels and sweats to cool itself down. The dilated blood vessels produce redness and a sensation of heat in the skin, but although the skin itself may become several degrees warmer than normal, the body’s underlying temperature remains unchanged. Even if the skin hardly becomes warm at all, the woman will still feel hot – usually uncomfortably and embarrassingly so.

Flushes can be triggered by several things – or by nothing. Common causes of a flush are: anxiety, hot weather, moving from a cold room to a hot one, drinking tea, coffee, alcohol or hot drinks, or eating spicy food. However, most flushes don’t seem to be triggered by anything. As smoking reduces oestrogen, smokers tend to find flushes more troublesome than non-smokers do.

If you get hot flushes, you may feel freakish, and wonder if everyone is staring at you. In reality, the chances are that no one will notice, and, far from being a freak, 75 per cent of women going through the menopause get hot flushes, just like you. Of that number, 80 per cent still have them a year after they first appeared, 25 per cent still have them five years later, and for an unfortunate 5 per cent, they continue indefinitely.

For some women, coping with difficult menstrual bleeding or painful periods without drugs or surgery is an option worthy of serious consideration. The rationale for a ‘watchful waiting’ approach hinges on the well-established finding that oestrogen plays a major role in the growth of fibroids and endometriosis. When oestrogen output by the ovaries decreases after menopause, these conditions tend to become much less worrying. Many women are therefore prepared to give the watchful waiting approach a try if their period problems are bearable and they are nearing menopause.

Julia experienced intermittent, heavy and painful bleeding due to fibroids for two-and-a- half years before her menopause and considered having either a myomectomy or a hysterectomy during this difficult time. Looking back some years later Julia was pleased that neither procedure was ultimately necessary.

There are many reasons for difficult-to-manage bleeding patterns apart from fibroids. Lauren had lengthy menstrual bleeds in her late forties that were different from anything she had experienced previously. During them, spotting was typical on the first few days, then there were several days of heavy bleeding which resembled the heaviest bleed of former periods, followed by a handful of days when the bleeding tapered off. Managing the blood loss was tiresome because it went on for so long and Lauren was also concerned about the possibility that something was seriously amiss. Medical investigations including a hysteroscopy did not reveal any suspicious lumps or growths and showed that she was not anaemic. Doctors said changes in her sex hormone levels, consistent with an Impending menopause, were to blame for her symptoms. In order to sort out whether Lauren’s blood loss was excessive, it was suggested she record what her bleeding was like. ‘Keep a diary of how many days it lasts, how many and what sort of sanitary pad or tampon you use, whether pain occurs and when,’ her doctor said. ‘Then we’ll discuss the findings.’

An increasingly common cause of bleeding in the post-menopausal age group is hormone therapy. Sometimes there is no apparent reason why such problems affect one woman and not another. Occasionally the explanation seems to be pre-existing fibroids or the use of an oestrogen implant as part of post-menopausal hormone therapy. It has been noted that implants cause severe uncontrollable bleeding in some women, presumably because they deliver larger amounts of oestrogen than other hormone therapy formulations, for some of the time at least.

Another possible cause of bleeding is cancer of the endometrium in post-menopausal women who have used oestrogen therapy (in pill, patch or implant form) without added progestogen for several years. Even after oestrogen is no longer taken, the risk of cancer of the endometrium persists. It is important to seek medical advice promptly if this possibility applies to you.

The decision about whether to watch and wait or to try medical treatments or surgery depends on many factors including the amount of bleeding and its effect on daily living, the ability to cope with such difficulties, general health, the rate of change in conditions like fibroids, and the probable time to menopause. Situations in which watchful waiting is generally considered to be inappropriate include rapid fibroid growth resulting in a significant and measurable increase in the size of the uterus during a six-month period, bowel or urinary obstruction, and symptoms which make life seem hardly worth living.